Int. J. Morphol., 36(4):1305-1309, 2018. Assessment of Scapular Morphometry Evaluación de la Morfometría Escapular Neslihan Boyan1; Esin Ozsahin2; Emine Kizilkanat1; Roger W. Soames3 & Ozkan Oguz1 BOYAN, N.; OZSAHIN, E.; KIZILKANAT, E.; SOAMES, R. W. & OGUZ, O. Assessment of scapular morphometry. Int. J. Morphol., 36(4):1305-1309, 2018. SUMMARY: The current study was undertaken to assess the incidence of different types of suprascapular notch, acromion dimensions and the lower and upper scapular angles. The suprascapular notch and variations of the acromion are clinically important in suprascapular nerve compression and subacromial impingement. Measurements were taken from 73 Anatolian dry scapulae of unknown age or sex. The suprascapuar notch was classified according to that of Rengachary et al. (1979). Its width and depth, the distance between supraglenoid tubercle and the deepest point of notch, as well as the upper and lower scapular angles were also determine measured. The type of acromion was assessed according to shape (type I (cobra), type II (square), type III (intermediate)) and tilt (type I (flat), type II (curve). Acrmion length and the distance between acromion and coracoid process were also measured. The frequency of different types of suprascapular notch were type I (28.8 %), type II (23.3 %), type III (13.7 %), type IV (20.5 %), type V (2.7 %), type VI (5.5 %)and absence (5.5 %). Acromion type were type I (45.5 %), type II (7.5 %) and type III (47.0 %), acromion tilt type I (15.2 %), and type II (84.8 %). An understanding of the association between the anatomical structures of the scapula and morphometric measurements is clinically important. KEY WORDS: Suprascapular notch; Acromion; Scapular morphometry. INTRODUCTION Scapulae have a complex anatomy due to their successful total shoulder arthroplasty or surgical treatment spesific irregular shape. This flat, triangular bone has two of disorders related to scapula and shoulder, as well as surfaces (costal and dorsal), three margins (superior, lateral shoulder arthroscopy (Ebraheim et al., 2000; von Schroeder and medial), three angles (superior, inferior and lateral) and et al., 2001). Furthermore, a clear understanding of the three bony projections (spine, acromion and coracoid morphology of the acromion, glenoid fossa, coracoid process process). It is a major component of the pectoral girdle and subacromial space is necessary to alleviate shoulder pain playing an important role in the varied and complex and rotator cuff insufficiency (Aktan et al., 1996; Getz et movements of the upper limb. It articulates with the clavicle al., 1996; Taskınalp et al., 2001). The cause of subacromial and humerus forming the shoulder complex. The three bony syndrome is compression of the soft tissues (rotator cuff projections give attachment to a number of muscles and muscles and subacromial bursae) in the subacromial space ligaments (Romanes, 1995; Soames, 1995). Clinical changes by the head of the humerus, acromion, coracoacromial associated with the various projections may modify the ligament and coracoid process (Ertem et al., 1990; Romanes; biomechanics of the upper limb. Anomalies of the shoulder Aktan et al.; Unal et al., 1997; Ebraheim et al.; Taskınalp et joint, including fractures, dislocations, arthritis, al.; von Schroeder et al.). Morphometric studies on the inflammatory and pathological conditions may also arise. subacromial space have confirmed the importance of this Many surgical approaches, such as arthroplasty, region. glenohumeral arthrodesis, internal fixation for the stabilization of fractures, acromioplasty and acromionectomy The variations of the suprascapular notch (SN) have for rotator cuff tendinitis all involve the scapula. A detailed clinical significance for suprascapular impingement knowledge of scapular anatomy is therefore essential for syndrome, while the determination of acromion type is 1 Cukurova University, Faculty of Medicine, Department of Anatomy, Adana, Turkey. 2 Baskent University Faculty of Medicine, Department of Anatomy, Adana, Turkey. 3 Centre for Anatomy and Human Identification, School of Science and Engineering, University of Dundee, Dundee, DD1 5EH, UK. PS: This manuscript was presented as a poster presentation at the IVth International Symposium of Clinical and Applied Anatomy (ISCAA), Ankara/ Turkey, 28th June – 1st July, 2012. 1305 BOYAN, N.; OZSAHIN, E.; KIZILKANAT, E.; SOAMES, R. W. & OGUZ, O. Assessment of scapular morphometry. Int. J. Morphol., 36(4):1305-1309, 2018. important in shoulder impingement (Aydinlioglu. et al., point were determind (Fig. 2). In addition, acromial length 1997; Prescher, 2000). Rengachary et al. (1979) reported and the distance from the acromion to the coracoid process six distinct types of SN (Urguden et al. 2004): it can be was also determined (Fig. 2). The angle between the lateral turned into a foramen by ossification of the transverse margin of the SN, the superior angle and root of the spine ligament of the scapula. The foramen then serves as a conduit was measured and considered as the upper scapular angle for the suprascapular nerve, which gives sensory branches (USA), while the angle between root of the spine, the infe- to ligamentous structures associated with the rior angle and infraglenoid tubercle was measured and acromioclavicular and shoulder joints and motor branches considered as the lower scapular angle (LSA) (Fig. 2). The to supraspinatus and infraspinatus (Aydinlioglu et al.; shape of the acromion was assessed as being type I (cobra), Bayramoglu et al., 2003; Urguden et al., 2004; type II (square) and type III (intermediate) (Fig. 3) and its Sabanciogullari et al., 2006; Ofusori et al., 2008). In some tilt as type I (flat) or type II (curved) (Fig. 4). cases variation of the transverse ligament accompany NS variations: these may play a role in entrapment neuropathies. Injury to the suprascapular nerve may result in loss of function of the rotator cuff muscles (Aydinlioglu et al.; Ticker et al., 1998; Urguden et al., 2004; Sabanciogullari et al.; Ofusori et al.). The acromion partly covers the humeral head: it articulates with the clavicle and gives attachment to the anterolateral portion of deltoid and coracoacromial ligament. Its association with chronic pain and shoulder dysfunction has been observed (Voisin et al., 2014; Nyffeler & Meyer, 2017). The morphometry of the acromion process is Fig. 1. Types of suprascapular notch: adapted important as it is related to pectoral girdle pathologies (Saha from Rengachary et al. (1979). & Vasudeva, 2017). Investigations into acromial morphology have largely been restricted to its shape and tilt (Natsis et al., 2007). Nevertheless, it has been classified into three different types: type I, flat; type II, curved; type III, hooked Fig. 2. Morphometric (Bigliani et al., 1986; MacGillivray et al., 1998; Mayerhoefer measurements of the scapula. et al., 2005; Natsis et al.). Type I is most common, while SNW, suprascapular notch types II and III are considered important factors in the width; SND, suprascapular development of subacromial impingement syndrome notch depth; TS-SN, distance (Mayerhoefer et al. 2005). There is a significant association between the supraglenoid between aspects of acromial morphology and rotatory cuff tubercle and deepest point of ruptures, as well as subacromial impingement syndrome, the suprascapular notch AL; acromion length; A-CP, commonly observed in orthopedic examination distance between the (Mayerhoefer et al., 2005). acromion and coracoid process; USA, upper scapular This current study was conducted to determine the angle; LSA; lower scapular clinical importance of scapular morphometry, particularly angle. of the suprascapular notch and acromion, and its variations. MATERIAL AND METHOD Seventy three intact adult scapulae of unknown age and sex from the anatomy laboratory of Cukurova University Medical Faculty were selected and examined. The suprascapular notch (SN) was classified according to the definition of Rengachary et al. (Fig. 1): its width and depth, Fig. 3. Type of acromion according to shape. Type I; cobra, Type the distance from the supraglenoid tubercle to its deepest II, square; Tpye III; intermediate. 1306 BOYAN, N.; OZSAHIN, E.; KIZILKANAT, E.; SOAMES, R. W. & OGUZ, O. Assessment of scapular morphometry. Int. J. Morphol., 36(4):1305-1309, 2018. shape the acromion the majority were type III (47.0 %), closely followed by type I (45.5 %) and then type II (7.5 %) (Table II), while according to tilt 84.8 % were type II and 15.2 % type I (Table III). The associated measurements for each type of acromion are also presented in Tables II and III. DISCUSSION Fig. 4.Type of acromion according to tilt. Type I; flat, Type II; hooked. For shoulder arthroscopy the distance of certain structures from palpable bone landmarks is vital to determi- RESULTS ne entrance points. The suprascapular nerve can be injured during arthroscopy associated with the suprascapular notch (von Schroeder et al.). Taser & Basaloglu (2003) Table I shows the linear measurements and angles demonstrated significant differences between sexes in the associated with different SN types. The SN types observed distance between the edge of coracoid process and the were; as type I (28.8 %), type II (23.3 %), type III (13.7 %), suprascapular notch, while von Schroeder et al. observed type IV (20.5 %), type V (2.7 %), type VI (5.5 %): a notch that all measurements of the coracoid process were different was absence in 5.5 % of specimens (Table